he eg 36 ibs ans tic tions, cts ols tell Clin, Biomech. 1992; 7: 108-119 Anatomy and biomechanics of psoas major N Bogduk ms Bs Pho", M Pearcy BSc PhD CEng’, G Hadfield Be Bed" ‘Faculty of Medicina, University of Newcastle, Newcastle, Australia, and *D y lewcastle, Newcastle, Australia, and *Department of Orthopaedic Surgery and Treuma, Royal Adelaide Hospital, Adelaide, Australia Summary ‘The fascicular anatomy of the psoas major was determined by dissaction in three cadavers, Its actions on the lumbar spine in the sagittal plane were modelled on erect, flexion, and extension radiographs of ten adult males. Calculations revealed that psoas exerts only very Small moments that tend to extend the upper lumbar spine and to flex the lower lumber Spine, but at maximum contraction the psoas exerts severe compression forces on the lumber segments, and large shear forces. ‘The results deny any substantial role of psoas as a flexor or extensor of the lumbar spine but reves! that activities involving psoas exert large compression and sheer loads on the lumbar joints, Koy words: Lumbar vertebra, muscles, biomechanics, psoas major Introduction ‘The psoas major is well known as a flexor of the hip'?, bat unlike any other muscle of the lower limb, the psoas arises from the lumbar spine. This feature implies that if the lower limb was fixed, as for example, in the standing position or in the exercise of sit-ups, psoas could have an action on the lumbar spite. Electromyography studies show that the psoas is active duting upright standing and during forward bending and lifting’. ‘These observations prompted the inference that psoas major might function as a ‘stabilizer of the lumbar spine’, Others have proposed that psoas controls the lumbar lordosis® and balances the bodyweight in relaxed upright standing*. However, electromyography is limited in its power to define the actions or functions of a muscle. It shows only that the muscle is active duringa movement, but it does not reveal the force exerted, or whether the imuscle is generating the movement or is exerting some “other action. Moreover, single-electrode studies do not reveal what effect a large muscle like psoas major has a Received. 15 February 1991 ‘Accepied: 20 May 1981 Coreapondence and reprint requests fa: Dr N. Bogduk, Faclty of Mediene, Univoraty of Neweastlc, Newestle, NSW 2308, Australia © 1992 Butterworth-Hicinemann Ltd ‘0258 -0033/921020109~ 11 fon each and every segment of the lumbar spine to which it is attached. Yet, such information is necessary if one is to appreciate what effect exercises involving ‘the psoas have on either the normal or impaired lumbar spine. "To determine the segmental actions of a muscle certain items of information are required. The exact sites of attachment must be known, together with the Tines of action of the muscle with respect to each and every joint that it erosses, and the relative size of the ffbres acting on each joint. In the case of psoas major, textbook descriptions do not provide sufficient detail to tenable this type of information to be derived with any certainty. The present study was therefore undertaken to determine the segmental morphology of the psoas major in order to explore its actions on the lumbar spine. ‘Methods ‘The study was undertaken in two phases. First the morphology of the psoas major was determined by dissection, Subsequently its actions were modelled on flexion extension radiographs of the lumbar spine. Morphology ‘The morphology of the psoas major was studied by dissection bilaterally in three embalmed, human adult 4110 Clin. Biomech. 1992; 7: No2 male cadavers of donors aged in excess of 60 years. In each cadaver the muscle belly of psoas major was isolated by resecting the abdominal contents and the quadratus lumborum muscle. The iliopsoas tendon was isolated by removing the anterior muscles of the thigh. Upon stripping the iliacus piecemeal from its attachments to the ilium and to the iliopsoas tendon, the tendon was left with only psoas major attached to it. The tendon was then transected caudal to the lowest attachment of any fleshy fibres of the psoas major. This enabled the belly of psoas major to be stripped systematically Starting with the fibres with the most rostral and ‘most anterior attachments to the vertebral column, small bundles of muscle fibres were gathered with forceps, detached from the vertebral column, and stripped caudally. As each bundle of muscle fibres was stripped, its tendons were peeled from the belly and main tendon of psoas major, and a note was made of their disposition and attachments. The sites of attachment of the resected bundles were recorded on tracings of anterior and lateral radiographs of a lumbar vertebral column, ‘Once resected, each bundle was trimmed of any tendinous fibres leaving only a bundle of fieshy, muscle fibres, The length of this bundle was measured with a rule to the nearest 0.5cm, and its volume was measured to the nearest 0.5 ml by immersing it in a volumetric cylinder filled with water and recording the fluid displacement. ‘These two measures for each bundle were used to calculate its physiological cross-sectional area (volume divided by length). Once all six muscles had been totally resected, their sites of attachment were reproduced on a single tracing of a lateral radiograph of the lumbar spine to produce a composite map of attachment sites. This map depicted what could be construed as the fascicular anatomy of psoas major. A fascicle was defined as a group of muscle fibres that shared a common, discrete arca of attachment on the vertebral column that was discontinuous from other areas of attachment, and which differed from other areas in terms of the vertebra or parts of the vertebra to which it was attached Biomechanics ‘The possible actions of psoas major were modelled by plotting the attachments and lines of action of its ‘component fascicles on tracings of anteroposterior and lateral radiographs of ten normal subjects in the erect, fully flexed, and fully extended postures of the lumbar spine. These latter movements had been executed with the pelvis clamped in the upright standing position, and so constituted lumbar motion in the absence of hip movement. The radiographs used were those described and used in previous studies of the movements of the lumbar spine using biplanar radiograpby’. The location of the instantaneous axes of rotation of each segment for every individual had also been determined in a previous study* and were recorded on the tracings, The vertebral attachments of every faseicle of psoas major were marked as points on the tracings, The Points used corresponded to the centroid of the area of attachment of euch fascicle as recorded on the composite map constructed during the morphology phase of the present study. To establish the line of action of cach fascicle, a line was drawn from its vertebral attachment site to a common point thet marked the location of the iliopsoas tendon, This later point was plotted immediately anterior to the iiopubie eminence: the site where the iliopsoas tendon leaves the abdominal cavity and curves posteriorly towards the lesser trochanter. Such fines of action were constructed for every fascicle on cach of the tracings of the erect, flexion, and extension views of each of the ten subjects. For the erect posture, the following parameters were measured or calculated for each fascicle in euch of the ten subjects ~ the length of the moment arm at each segment crossed by the fascicle, the distance between its origin and the iliopubie eminence, the orientation of the fascicle, the maximum force exerted by the fascide in the sagittal plane, and the moment, compression force, and shear force exerted on each segment. The present study was restricted to considering actions of the psoas major only in the sagittal plane because the locations of the axes of rotation for lateral flexion ofthe lumbar spine are not known with any certainty. Consequently, lateral bending moments could not be determined. Moment arms were measured from the tracings as the perpendicular distance between the line of aetion of the fascicle and the instantaneous axis of rotation for each segment that the fascicle crossed, The direct measurements obtained from the radiographs were corrected for magnification due to divergence of the X-ray beam used to obtain the radiographs (a factor of 1.62), Moment arms acting in front of an axis of rotation so as to cause flexion were recorded as positive, and moment arms bebiind the axis of rotation S0 as to cause extension were recorded as negative. ‘The distance between the origin of each fascicle and the iliopubic eminence was measured directly from the tracings of the lateral radiographs and corrected for magnification to obtain a true projected length. This measure was used subsequently to determine the orientation of the fascicle and to calculate changes in length of the fascicle following flexion or extension of the lumbar spine. The orientation of each fascicle was determined using the geometrical relationships depicted in Figure 1. For a given fascicle with an origin at O and an insertion into the psoas tendon at I, the fascicle exerts a maximum force (Faux) represented by the interval OL ‘The projection of T in the sagittal plane is P, and the interval OP represents the force exerted by the fascicle in the sagittal plane (Faq). OP can be measured from lateral radiographs on ‘which P and O have been marked, The interval PI represents the lateral displacement of the insertion of the fascicle and theBogduk et al.: Anatomy and biomechanics of psoas major 111 ° Coronal plane Figure 1. Graphical representation of a muscle fascicle arentated obliquely in three dimensions and the projections of ts orfentation in the sagittal end coronal planes. With an origin from the vertebral column at O tnd an insertion into the psoas tendon at | the fascicie exerts a maximum force (Fines) represented by Ol. The projection of in the sagittal plane is P, which constitutes the site of insertion as seen in lateral radiographs. The projection of lin the coronal plane is L, which constitutes the site of insertion as seen in anteroposterior radiographs. The interval OP represents the force ‘exerted by the fascicle in the sagittal plane (Fag) The angle jis formed betwoen the intervals OP and Ol in the tangle PO. projection of Iin the coronal plane is L, The magnitude of PI is equal to that of AL which can be measured from anteroposterior radiographs on which O and L have been marked. If y.is the angle POL, Fin, and Puy ate related by the equation Fang ™ Fenn 608 « A representative value of the angle for every fascicle was determined using the relationship. ‘an 4 = mean Pi/mean OP @ Where mean PI and mean OP were the mean values respectively of the length and lateral displacement of the fascicle in question as determined from the plots of the fascicle on the radiographs of each of the ten subjects For every fascicle, its maximum force of contraction was expressed as a function of the mean physiological cross-sectional area (PCSA) for that fascicle as determined in the morphological phase of the present study. The force was expressed in the form Fuux PCSA x K, where K is a force coefficient with the units Nem”, For muscles in general, the value of K is believed to lie in the range 30-90 N cm™? 9", but the value that applies specifically to psoas major has not been determined. Consequently, for the purposes of the present study, K was treated as an unknown, This precluded calculating the absolute magnitude of the force of any fascicle but nevertheless allowed the relative forces exerted by any fascicle or on any segment to be assessed By combining the representative angle 4 for each fascicle with its representative force (Fyysz) the representative force it exerted in the sagittal. plane (Frag) could be calculated using equations (1) and (2). ‘The compressive force (F.) exerted in the sagittal plane by the fascicle on its vertebra of origin is given by the equation FR, Frags @ Where J is the angle between the line of action of the fascicle in the sagittal plane and the transverse plane of the vertebra to which it is attached (Figure 2) Similarly, the shear force (F,) exerted by the fascicle is given by the equation Fe= Fagg 0082 @ To determine the value of A for each fascicle at each segment, lines were drawn on the tracings of the lateral radiographs of each subject through the inferior vertebral end-plate of each lumbar vertebra to represent the transverse plane of each vertebra. The angle formed between each of these lines and the line = Foss Fim Fost Foss Finds Fe= Fans Figure 2. Sketch of alateral view of three lumbar vertebrae crossed by a single fascicie of psoas major ‘which exerts a force in the sagittal plane (Fas). Lines drawn through the inferior end-plates of the vertebrae depict the transverse plane of the vertebra, The angle formed between the transverse lines and the line of ‘action of the fascicle can be used to resolve the force of the fascicte Into compression forces (F,) and shear forces (Fu112 Clin. Biomech. 1992; 7: No2 of action of any fascicle that crossed it was measured in all ten subjects. A representative value of J for each fascicle at each segmental level was determined by averaging the values of 2 for that fascile and segment as measured in the lateral radiographs of the ten subjects studied. By combining this representative value and the representative value of Figg for each fascicle, the representative values of the compression and shear forces of the fascicle were derived using Equations (2) and (3). Representative values of the moments exerted by each fascicle at each segment were calculated by combining the representative value Of Fyy for that fascicle with the mean value of the moment arm at each segment as measured from the lateral radiographs of the ten subjects studied. To determine the possible actions of psoas as a flexor and extensor of the lumbar spine, its fascicles were plotted on the fexion and extension radiographs of the same ten subjects used for the erect posture. Using the same techniques as for the erect posture, the lines of action ofthe fascicles were determined along with their moment arms. The representative moments exerted by cach fascicle were calculated as the product of the representative force exerted by each fascicle in the sagittal plane (Fy,) and the mean moment arm for each fascicle at each segment that it crossed. The change in length undergone by each fascicle in either Hexion or extension was determined by subtracting the distance from its origin to the iliopubie eminence in the flexion or extension posture from the corresponding distance in the erect posture, all lengths having been corrected for magnification on the radiographs. After measuring the orientation of each fascicle with respect to the long axis of each vertebra, compression and shear forces for cach segment were caleulated as for the erect posture. Results Morphology Inspection ofthe intact psoas major suggests that itis a homogeneous muscle with a continuous attachment to the vertebral column at one end, tapering to a single, round tendon at the other end, Dissection, however, reveals that the muscle consists of a’ series of overlapping segmental fascicles. Each fascicle consists of bundles of fleshy fibres that arise from a discrete area on the lumbar vertebral column centred on either an intervertebral dise or a transverse process. Five fascicles arise from the T2—Ly to Ly-Ls dises and five fascicles arise from the LL transverse. processes. Additionally a fasticle arises irregularly from the Ls vertebral body. At each segmental level, those fascicles centred on the intervertebral disc were found to arise from the posterior seven-eighths or so of the lateral surface of the dise (extending as far posteriorly as the intervertebral foramen) and from the lateral surfaces of the vertebral bodies immediately above and below the dise (Figure 3). Those fascicles from the Ly-Ly to Figure 3 Sites of attachment of the fascicles of psoas ‘major. The areas of attachment for each fascicle as see Insix specimens have been superimposed to determing the extent of variation and the areas consistently shared by all specimens {represented by the darker shading), The centroid of this latter area (white dot) was adopted for biomechanical purposes as the representative point of attachment ofthe fasciele, Ly~Ls discs were centred just posterior to the midpoint of the dise as seen in a lateral view. The fascicle from Tra to Ly extended more onto the L vertebral body than to Tia and was centred over the upper, posterior, lateral comer of L, (Figure 3) The fascicles from the Ly to Ls transverse processes occupied the medial three-quarters or so of the anterior surface of the transverse process while the fascicles from Lzand L; occupied only the medial one-quarter? the transverse process. ‘The fascicle from the Ls vertebral body, when present, arose from an obliquely set area on the lateral surface of the Ls vertebral body extending upwards and forwards from the posterior, inferior comer of that surface (Figure 3). Fascicles from the LiL to Ly=Ls dises and from the L, vertebral body were regularly present, as were fascicles from the Ly and Ly transverse processes. Fascicles from the Ly, Lz, and Ls transverse processes Were missing unilaterally in one or two specimens. ‘The fascicle from the Ls vertebral body was the least constant, being found in only three muscles in two specimens (Table 1), The fibres in each fascicle passed caudally and slightly laterally to join the tendon of psoas major. As measured from their point of origin to where they become tendinous, the fleshy fibres of each fascicle Were remarkably similar in length. Within the same specimen the fibres had the same length (to withinBogduk et al.: Anatomy and biomechanics of psoas major 113 Table 1. Morphometric data on the fascicles of psoas major detailing their prevalence (n} in six muscles in three cadavers, their volumes, lengths, and physiological cross-sectional areas (PCSA) Volume _frnl) Length fom) PCSA (cm *) fascele "igen 30 Mean 50 Fy Wve 8 mea 6S 1378 ee LebND 6 m1 102 3714s i Lew 82, 59 a7 14181038 Le 6 ez 82 sy ast LUND 6 2600 613374 Ph \elND 6 8B 6237 tate i ue 33083079 ae Fasicles are dented by thelr aegmontal origin and atach manta the ‘abr body (VB), trantvarse process (Tor intervertebral dis (VO), 05cm) regardless of their level of origin. Different, specimens exhibited quite similar lengths of fascicles (14, 15, and 12 em respectively). Within the body of the intact psoas major the various fascicles were arranged systematically from before backwards and from above downwards, Across the belly of psoas major, the fascicles were arranged in a laminated fashion, with those from higher segmental levels covering the anterior and then medial aspects of those from successively lower levels. This endowed the ‘muscle with the appearance of having been twisted medially (which is consistent with the rotation of the lower limb undergone during development). The laminated structure of the muscle was propagated into its tendon, The tendon of the Ly~Ls fascicle formed the central core of the common tendon while the tendons from successively higher levels wrapped citcumter- eatially around this core. From above downwards the fascicles were staggered. Because each fascicle had the same length, fascicles from higher levels became tendinous while still covering fleshy fibres from lower levels, such that the fascicle from Ls was the last to join the psoas tendon and was still fleshy while all others had become tendinous, In terms of relative size, the fascicles from transverse processes were generally smaller than those from the ipsisegmental disc (Table 1). From Tiz-Ly to Ly=Ls the fascicles were of comparable size, but the fascicles from the Ls vertebra were conspicuously smaller. Biomechanics From its origin, each fascicle passes downwards, Figure 4, The sites of attachment (shaded areas) and the lines of action of the fascicles of psoas major as seen in anteroposterior projection. laterally and forwards to reach the psoas tendon. From above downwards the fascicles assume progressively less steep orientation with respect to the long axis of the vertebral column in both the anteroposterior and lateral projection (Figures 4 and 5). The lateral deviation of each fascicle as it passes caudally is not great, amounting to between 11° and 23° (Table 2). This results in virtually all of the force of the fascicle being exerted in the sagittal plane (Table 2), Figure 5. The lines of action of the fascicles of psoas major es seen in lateral projection. The points marked as the oFigin of each fascicle are the centroids of the areas of attachment (Figure 1). The large dots below each vertebral body mark the location of the instantaneous axis of rotation of the vertebra above. a, erect posture; by, full flexion of the lumbar spine; ¢, full extension of the lumbar spine,114 Clin. Biomech. 1992; No2 Table2. Morphometric and trigonometric parameters ofthe fascicles of psoas mejor in the erect posture I (mm) OP mm) “ f Fascicle a cos no ‘Mean 30 ~—~«Mean—s~—«egrees) uve 46 " 243 6 un 2K 24K TP 46 10 235 18 ui 081k oBK U-b v0 4 10 28 16 2 211K 24K Lat a 10 207 ” 1 101K 10K ely M0. 8 10 188 ” B 181K 18K TP 38 9 73 6 2 173K 17K U-Lalvo 8 8 181 6 16 191K 18K TP 36 7 iat “4 14 420K 12K U-LsvD 2 8 n7 8 20 119K 19K GTP 3 5 16 u 6 038K 03K uve 2 5 100 2 2 079K 07K earthen leplearartaf the cel ono the Inngtof he asce tram sorigin oth opt fate The foes Fran ithe amu fren of “noes nic npess et ried negra ogi nd atcha ar oy nue cen Po ner VDP len tne lopsoes tendon renee, spolacegin tha sagt pane The engl she ong eliopeble eminence) wit ospctotarign, OP the ubsondodby Plat thaorgh oe the rod ots prysaogel orca sotionl ares andthe free cobficen, K whossvaluelsurkronn but whose mensions sreN ar* The fre Pgs th foes oxrasby te fence Inte agi pane In the erect postute, the fascicles assume various relationships wit the instantaneous axes of rotation of the lumbar motion segments, One example is illustrated in Figure Sa, which shows that fascicles from different levels run behind some axes but in front of others. The exact relationship between a given fascicle and a given avis varied, however, from subject to subject. As a consequence, not only the length of the moment arm but also its ditection varied. The average ‘moment arms and their directions for all ten subjects are summarized in Table 3. Overall, the moment arms are quite short, the longest occurring at the Ls-S; level bbut measuring not more than 31 mm on the average. Coupling the data on moment arms and physiological cross-sectional area allows the relative forces exerted Table 3. Mean magnitudes and so of the m: by the psoas on each segment in the erect posture to be calculated (Table 3). It is evident from this table that the magnitude of the maximum moments that can be exerted by each fascicle and by the fasciles collectively are quite small, but moreover, in the upright posture psoas exerts a net extension moment on the upper three lumbar segments. Only the lower two segments are flexed by psoas In lateral projections of the erect posture, the {fascicles of psoas major from above downwards assume a progressively less steep orientation with respect to their vertebra of origin. As a result of this, the upper fascicles exert relatively more of their force in compression than in shear (Table 4). From above downwards, the total compression loads and total roment arms (Ma) ofthe fescicles of psoas major for each segmentthat a fascicle crosses, a determined in ten subjects, end the mean maximum moments (Mo) that could be exerted By each fescicle on each lumbar motion segment in the sagittal plane in the eroct posture ‘Moment arms (mm) and moments (N m x 10°?) by segmental level Fascicle bine berks berks bets LJ Oe ee ee Lye By Kt 7 kK a7 aK oto kT. ure 8 BK 7 7 sok 07 ek Gf EK eta pe a eee eee Kee oh eke ia ioe cok a tal ek irae “8 8K 26 2K G10 GR kk ba 4 2K 4 6 BK 8 oak 13 SOK. LT “M4 mk 3g “bk 2 7K tot 24 4K BB aK 3010 ak. U-betvD 208 2k 20K tele 6 3 7K 2 8 BK a 8 7 2K nm 6 8K ‘Summ m x 109) 25K 45K Ancauivesgninge UuniseN m x 10-*ands mutples of ores coeficant& nhose va {har sepmanaoriginendauachmen tthe veretral poy WV), tendon moment am and momen ear vaBogduk et al.: Anatomy and biomechanics of psoas major 8 Table 4. Mean magnitudes and (so) of the orientation (A, degrees) of each fascicle of psoas major with respect to the transverse plane of each vertebra on which the fascicle acts in the erect posture and the mean maximum compression force (F.) and shear foree (F,), measured in Newtons, exerted by each fascicle on each segment Orientation (hj, compression foree (F,) and shear foree (F,) by segmental level Fescole ~ tre tele ie me Oe Foo Fe ek Fe Pe 21K 906) 21K DOK 8716) 21K OIK 7916) 21K O4K G7) 19K ORK GIB) 16K 19K GSK 8716) BK OOK Bal) GOK OTK 7eIB OOK GIK GAT OSK O3K 45/9) OAK OAK ne faig) 21K BIR BW] QIK OK GA) TOK OBR sale) TTR 19K vow Bs] TOK GIK 718) 10K O2K G47 OSK OAK 45ia) OPK O7K ek Bla} 1EK 02K 70) 13k OSK Sal) 13K OOK ak 768} TER Oak Gala) ISK OTK Alo) 12K 12K rake Tos} 17K OBK 20) Lae LAK 12k Gris) OR OBK a2lin) Ose osK wae fez) OK O8k oR bara) 02K 02K OK aria) 04K 8K sum (compression) 27K 58K 90K rask awsk Sum shone 00K. oak 18k ark ask Fercs are oxpronsod a2 muiiplos ofa for coelidont K whose anterior shear loads on the lumbar motion segments increase, and the Ls~S, segment is subjected to almost as much shear as compression (Table 4). Flexion of the lumbar spine has the effect of shortening the fascicles of psoas and altering their relationship with the instantaneous axes of rotation, thereby altering their moment arms (Figure 5b). Upon flexion of the lumbar spine, without hip flexion, the upper fascicles of psoas shorten by 5~14 mm while the lower fascicles exhibit little change in length (Table 5). ‘The moment arms of fascicles increase in magnitude in positive sense; flexion moment arms become larger and extension moment arms become smaller or convert ieunknown butwh mental origin and attachment to tne vortbral body (VB), reneverse proc o dimensions are Nem #,Feelelos are lentiod by thar ITP), or mervortbra sis (NO). to flexion moment arms (Table 5). The upper fascicles of psoas exert flexion moments instead of extension moments. The flexion moments exerted on lower lumbar segments are appreciably larger than in the erect posture but overall, all moments remain relatively small (Table 5). Upon fiexion the orientation of the fascicles with respect to their vertebra of origin changes both because of the sagittal rotation that each vertebra undergoes and because of the forward displacement of the vertebra as the lumbar spine flexes. Consequently, the compression force exerted by each fascicle decreases as its shear force increases (Table 6). The total Table 5. Changes in length undergone by the fascicles of psoas major upon assumption of the fully flexed position of the lumbar spine, the mean magnitudes and so of the moment arms (Ma) of the fascicles for each segment that a fasciolo crosses, as determined in ten subjects, and the mean maximum moments (Mo) that could be exerted by each fascicle on ‘each lumbar motion segment in the sagittal plane in full flexion of the lumbar spine (Moment arms lom) and maments (Nm x 10~4) by segmental fevel change in Fascicle length fom) ‘Moan so tants bark Maso Mo Ma so Mo Ma so Mo Ma so Mo Lys “48 8 6 19K 2 8 4K 33 7 OK 4 7 S7K 87 10 120K ute “307 8 8 3K 10 7 «8K 27 67 «18K 34 «8 «20K 52 10 IK Labs IVD a 6 4 4 8K 17 7 aK 30 6 8K 4 7 90K 55 10 118K ure “6 6 6 Bk oo 8 MK oS 7 81K 46 10 4K UL VD. 36 3 3 «10K «20 4 BK 39 8 62K 50 9 BOK Gre <8 4 0 4 0K 2 6 37K 39 9 GOK GeLsivD, 0 4 8 3 NK 2% 4 47K 8 7 76K ure’ -2 3 7 8 8K 2 8 32K UnLy IVD. 43 8 3 SK 2% 8 3IK ure 0 2 9 6 3K eve 12 12 6 8K Summ (N mx 10°) 24K 6K 205 K 401K 609K [negative sign Indjcates an extension mamentarm snd moment: all other values are flexion momant 2 ASN ore ctao oe multples ofa for coetient Kc wnose value faunknown but whoge dnenalona weuls be cm* Fascia are tele segmental origin and attach roneverse proses (TP, orintervereoral io (WD).116 Clin, Biomech, 1982; 7: No.2 Fascicle rina comprstion force (and shear free (F) by segmental evel Toh teh 5) fee ree meer _ aoe A 40) 19x sil) 18k 08K 75) 20K 07K 9%) 20K OBK sx) 19K 19K S71 O5K 03K 4) OFK GIK OB) OSK OZK Gals) OBK CIR Sue) DEK O8E Sele) 18K 08K O95) 20K ORK 7K) TSK OBK GOS) NOK LIK S84) 09K O8K B15) 09K O5K BOK) OSK OSK SIS) GER OBE Sag) SAK O7K G3i) MAK O7K G77) S3K O8K Bis) MAK TOK 5318) 14k TOK a7] 12K 12K SSI) 18K 10K apa) Lak 12k 4517) OBK OOK Ssiio) OPK OOK aan] 07K 09K nana) 01K 03K rand) 03K 06K ‘um compression) 24K 52k a2k raak work Sum she 12k 25k ak sax 80K Fores ae expresso as ml of sores coat, K whose vl segmental ign and attach compression force on each segment differs litle from that exerted in the erect posture. The shear force exerted on L;-S; is about the same 2s in the erect Posture but is somewhat larger at higher levels (Table 6. Upon extension of the lumbar spine without hip moveinent, the fascicles of psoas lengthen slightly and their moment arms change (Figure 5c, Table 7). The ‘upper lumbar segments are subjected to extension ‘moments that are substantially larger than those exerted in the erect posture. The Ly and L segments Femain subject to flexion moments but these are smaller than those experienced in the erect posture Table 7. Changes in length undergone by the fascicles of psoas major upon assum '2aN magnitudes and so of the moment arms. {rosses, as determined in ten subjects, and the mean maximurn mo the lumbar spine, the m teach lumbar motion segment in the sagittal ‘Mament arms (mm) and momants Nm x 10 unknown bt whose dimensions ara Nem # Fesccos ae ented by thor the verabrelbody (V8, trenevaropracate TP) or tarveraoral dn (WD), (Table 7) Extension alters the orientation of the fasciles with respect to their vertebra of origin, As a result the compression foree and shear force exerted by each fascicle changes. In extension the compression force af each fascicle und the total compression force on each Segment are not greatly different from those exerted in the erect posture (Table 8). Shear forces at lower lumbar segments in extension are not greatly different from those in the erect posture, but at upper lumbar levels, shear forces are reversed by the posterior sagittal rotation of the upper lumbar vertebrae, and Posterior shear forces are exerted (Table 8). ption of the fully extended position of (Ma) of the fascicles for each segment that e fascicle ments (Mo} that could be exerted by each fascicle on plane in full extension of the lumbar spine *) by segmental level Change in Fasccle Aength Imm) a ‘Mean 30 ty beely birke Lele Mo Maso Mo Ma so Mo Mo s0 Mo Ma so Mo uve 1 2K 17-7 36K 9 OK 18 14 38K ur “1 “4K 5 6 C8 9 3k 4 aK Eko 4 “4K “8 6 ok 8 1K 2 4 4Bk ie ! 2 5 “aK 9 4K 18 13 18K ah 4 0 4 OK 8 ik 2 13° 40K OT 2 7 3K 18 1 ZK ou 3 5 2K 2 09 47K ca z 5 8k 4M 8 WK tet 3 34K om 7 BBR ue 1 7 0 2K 2 iOencl 7k ‘Sum Nem x 10%) ~8K 90K “2k 24K 272K reat dente tn exenaion morantarm and moment al ether values we fesian monontammnova ot seperti aa abst fre coaclnt Kmhoeewueicuninownsen share See ee a Mamas ar expressed in Sev onal oinend onaimente veal Se Fo crn acon” No” Per eae by rerseprocess (Tor mervertebral due IV}Bogduk et al.: Anatomy and biomechanics of psoas major a7 Table 8, Mean magnitude and (so) of the orientation i, degrees!) of each fascicte ofp jor with ro , : ‘of psoas major with respect Tata taane'sfeeeh vertebra or which te fescec actin th uly extended postion of helummbarspine.a8 determined in 10 subjects, and the mean maximum compression force (Fe) and shear force (Fa), measured in Newtons, exerted by each fascicle on each segment Orientation (4), compression force (F,) and shear force (F,} by segmental level fascite Tele int tle is LK Lo fe fe fk fe FeO Be 21K 9019) 21K -09K 924) 21K -01K 217 29K 99K ETB 18K OBK 4am She SNS SSK SNE Ge ek “Soe far Sak Bie eles Ob aSk Sen cak aoe Si) 29k -o2e mol 2 O2k 705) 20K O7K Sil) eK 13k Sis tok OOK fie 1K oak Gol) OOK CAR aaa) O8K ik Ho) 18k 1k Ta) TSK OSK San 13k We i) 19e O9k oh Wek OTR a Tak rae Yan) 17k VOR oWo) USK 13k Bae) 3K aSe sen) Ok ire sin) ek oak fou) ok ork aan) OK 8 um feompresson) a7 oox. atk nak oak Sim choo -oaK -oak 12K aa 92K. Forses ore axpraseod as multiples of «fore coaticiont, K, whose value posariorehear ore Ii transverse proces (Ph orintorvartbral ie VO}. Discussion ‘The present study constitutes the first detailed examination of the fascicular and segmental anatomy of the psoas major. The muscle was found to consist of several fascicles with constant, discrete areas of origin, To form the intact muscle these fascicles are aggregated ina concentric, laminated fashion with fibres from high lumbar levels Spirulling anteromedially around those from lower levels, with the concentric lamination being propagated into the psoas tendon, Textbooks of anatomy emphasize the origin of psoas from tendinous arches that bridge consecutive intervertebral dises, forming a tunnel around the waist of the vertebral body that allows passage of the lumbar vessels and rami communicantes', Such distinet arches were not encountered in the present study. The deepest, most medial, fleshy fibres of psoas could be readily traced to distinct sites of attachment to an intervertebral dise or to the adjacent margin of the vertebral body. At most, any apparent tendinous arch fon the medial surface of psoas would constitute no more than a thickening of deep fascia at this site; it does not constitute a separate site of attachment. ‘A striking feature of the fascicles of psoas major was their similarity of length. Within a given specimen, the fascicles measured within a centimetre in length, and differences between specimens were not large. This morphological feature has a bearing on the purported functions of psoas major ‘As the lumbar spine bends in either the sagittal or coronal plane, upper lumbar vertebrae undergo a far greater arcuate excursion than lower vertebrae. Consequently, if psoas were designed to execute or control such movements, one would expect longer fascicles altaching to segments that underwent greater arcuate excursions in order to control this movement throughout its range. The fact that the fascicles of psoas ‘unknown but whose cimenslo aiher sheer forces are dcestad antenrly. Fayleles ara identified by thar sogmental origin anda are uniform in length suggests that, ¢o the contrary, the psoas is designed to act from the lumbar spine on the femur. With all fascicles of similar length, they would all undergo the same relative shortening and would share to the same extent the linear excursion of their common site of attachment on the femur. This inference is supported by consideration of the biomechanics of the psoas fascicles. Inall positions of the lumbar spine the lines of action of the fascicles of psoas run very close to the instantaneous axes of rotation of all lumbar motion segments. Consequently their moment arms are very small, and regardless of the size of any fascicle the moment it might exert is thus small, Furthermore, in different individuals the moment arms of upper lumbar fascicles vary from extensor to flexor in the erect posture, so there is no consistent design for these fascicles to be flexors or extensors. Upon assumption of the flexed posture of the lumbar spine, more fascicles become consistently flexor but the moments they produce are still compromised by very short moment farms, In extension upper lumbar fascicles are more consistently extensors, but inconsistencies pertain at both Ly—Ly and Ly—Ls (Table 7). Only the Ls~S; level is regularly subject to flexion moments by all fascicles in all positions of the lumbar spine, but even then the total moment is relatively small "The actual magnitude of the force exerted by psoas is fa vexatious issue because the value of the force coefficient relating maximum force to physiological cross-sectional area is unknown. For this reason, in the present study the value of the force coefficient has been treated as an unknown. Nevertheless, the results of the present study have been presented in such a way that once and if a value of the force coefficient is determined, the segmental forces can be readily computed, Meanwhile the tables of results illustrate the118 Clin. Biomech, 1992: 7: No 2 relative magnitude of moments, compression forces and shear forces exerted on euch segment and by cach component of psoas major. For the purposes of illustration, it is arguably defensible to assume a possible value of the force coefficient from the range ascribed to the back muscles", viz. 30-90N m~?. To this end, Table 9 summarizes the forces exerted by psoas major assuming a coefficient of SONom"?. This revealed that the moments exerted by psoas are relatively trivial: a maximum of 30.5 N m at Ls~S; in full flexion. This is barely a quarter of the moment required to flex the trunk at Ls from a supine position, On the other hand the compression forces and shear forces exerted by a single psoas muscle are considerable. Compression forces at Ly-Ly, Ly~Ls, and Ls-S; approach or even exceed trunk weight, while the shear forces at Ls~S, are approximately equal to trunk weight (Table 9). The forces are approximately the same regardless ofthe posture of the lumbar spine. Logitimate reservations may be raised concerning the confidence of these quantitative derivations. Apart from a proper value of the force coefficient, force calculations are reliant on accurate, representative measures of physiological cross-sectional area. The present data are compromised in this regard, On a small number of specimens, the volumes and physiological cross-sectional areas of the various fascicles showed considerable variation (Table 1) with coefficients of variation ranging between 21 and 55% for the regularly occurring fascicles. Furthermore, the morphometric data were drawn from elderly specimens, which could have had muscles that are smaller than those of average young or middle-aged adults ‘These limitations could be overcome by performing more dissections and in a greater number of younger specimens. However, it is questionable whether the putative additional gain in confidence would justify the investment necessary to overcome the logis difficulties of studying young specimens and the time required to perform multiple, meticulous dissections In this regard, we submit that the morphometric data presented here are not unrealistic, and reasonably represent the order of magnitude of forces involved In contrast, the geometric data presented are mote representative. The lengths, orientations, and isposition of the fascicles of psoas were derived from radiographs of young males. The variance in measures oof lengths and angles is tolerably small, and the maximum variations incurred would not alter the fal calculations by any more than a factor of two, Thus, whatever arguments might be raised concerning the confidence of the actual magnitude of forces, the present study presents reliable data on the changes and distribution of these forces in different postures ofthe lumbar spine, whereupon instructive conclusions may be drawn about the muscle and its action on the lumbar spine The psoas major is not designed as a prime mover of the lumbar spine. In all postures of the lumbar spine in the sagittal plane, the moments psoas can exert are very small. In the erect posture the psoas major tends to extend the upper lumbar vertebrae and to flex the lower lumbar vertebrae. ‘This aetion is accentuated in extension. In flexion all components of psoas tend to flex the entire lumbar spine, but even then the total moment exerted is alone not even enough to flex the lumbar spine in the exercise of sit-ups. What the psoas does dois exert substantial compression loads and shear toads on the Lumbar spine. In fac, its action in the erect or extended posture could be interpreted as vertically crumpling the lumbar spine in a sigmoid fashion forcing it into lordesis while severely shearing the Lz~S, joint. Those that prescribe sit-ups, either in sports training or in spinal rehabilitation should consider whether this isthe effet they wish to achieve by their prescription. ‘The shear force exerted on Ls~S; by maximum contraction of a single psoas muscle is approximately twice that exerted on this joint by trunk weight in upright standing. Whatever benefit might be gained by strengthening the psoas muscle by sit-ups has to be traded against the strain sustained by the LS; joints and the pars interarticularis that resist this shea ‘These conclusions are perloroe restricted to the actions of psoas major in the sagittal plane, The Table 9. Summary of the total representative maximum moments (Mo), compression force (F,) and shear force (F) Sxerted by the psoas major on each segment ofthe lumbar spine in the erect, full flexed and fully extended postures of the lumbar spine, assuming a force coefficient of 80 Nom-? ‘Moments, compression forces (F.) and shear forces (F,) by segmental lovel te = ole be Mo ff Mo Ff Mo FF = MoO, Mo fF wen) (iN) im) IN) IN) Wm) OND i) Om) A Erectpostura 13 138 «0 = 23 290 204.7450 61 545 235 17.8 80 470 Fall flexi 12 1 89 48 280 125 108 410 198 = ant Bad 9G NBEO Fullextension -23 195-200 ~45 290 -16 41 455 60 12 860 220° 13.6 540 460 ‘Anepstive sgn indleates a posterior shea force or extanaor moment.Bogduk et al.: Anatomy and biomechanics of pSoas major 119 absence of reliable cata on the centres of rotation for lateral flexion precluded a consideration of the actions of psoas major in the coronal plane. However, the fascicles of psoas exhibit litte lateral deviation from the sagittal plane (Table 2). Consequently the compression forces exerted by psoas during lateral flexion should be similar to those exerted in flexion and extension. One might conceive that the psoas is suited to be a lateral flexor of the lumbar spine because its fibres swing away from the vertebral column and gain appreciable moment arms, particularly at lower lumbar levels. However, at most the fibres of psoas major are displaced laterally from the vertebral column by not more than 46mm (Table 2). Consequently any moment arms would be less than this, which is of the same order of magnitude as the moment arms for flexion in the sagittal plane, which yield relatively trivial moments (Tables 5 and 9). Thus one should not expect psoas to be any better suited to be a lateral flexor than it is a flexor of the lumbar spine. Tp all, the morphology and geometry of the psoas major indicate that itis designed to act on the hip. Its attachment to the lumbar spine is only adventitious and does not imply any purposeful spinal action. Such moments that it exerts on the lumbar spine are irregular and relatively trivial in magnitude compared to the forces acting on the lumbar spine, but on the other hand severe compression loads and shear loads exerted ‘on the lumbar spine seemed to be the price paid for a well-designed flexor of the hip. Acknowledgements The authors wish to thank the Thermo-Fluids Group of the School of Engineering and Applicd Science, University of Durham, for supporting Dr Pearcy's sabbatical leave in Australia in 1987 when this work was initiated, and the Royal Society for financing his travel; we are indebted to the Oxford Orthopaedic Engineering Centre, for allowing access to the radiographs used in this study. 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